Assessment Scale Research Articles

Interrater reliability of RheuMetric checklist scales for Physician Global Assessment, inflammation, damage and patient distress

Abstract Objective To analyze interrater reliability of four RheuMetric checklist 0–10 visual numerical scales (VNS) of physician global assessment (DOCGL), inflammation or reversible findings (DOCINF), organ damage or irreversible findings (DOCDAM), and patient distress or findings explained by fibromyalgia and/or depression (DOCDIS). Methods A retrospective study was performed of data from a rheumatology fellows’ continuity clinic at Rush University. Each rheumatology patient with any diagnosis seen in routine care completed a multidimensional health assessment questionnaire (MDHAQ). Both the rheumatology fellow and attending rheumatologist independently completed RheuMetric estimates at the same visit for DOCGL, DOCINF, DOCDAM, DOCDIS, and the proportion of DOCGL explained by each subglobal estimate (totaling 100%). Agreement between the two assessors was compared using paired t-tests, Spearman correlation coefficients, intraclass correlation coefficients (ICC), Lin’s concordance correlation coefficients (LCCC), and Bland-Altman plots. Results In 112 patients, mean levels of DOCINF were highest in inflammatory diseases, DOCDAM in osteoarthritis (OA), and DOCDIS in primary fibromyalgia (FM). However, mean DOCDAM was as high as DOCINF in inflammatory diseases. No statistically significant differences were seen between scores from attending rheumatologists and fellows. Agreement within 2/10 units ranged from 60% for DOCGL to 71% for DOICINF and DOCDAM. Spearman correlations were 0.49-0.65, ICCs were 0.46-0.63, LCCC were 0.46-0.62 between rheumatologist and fellow, indicating moderate agreement; reliability was slightly higher for each sub-global VNS than DOCGL. Conclusion RheuMetric 0–10DOCGL, DOCINF, DOCDAM, and DOCDIS have moderate interrater reliability and are feasible in routine care to estimate patient status beyond DOCGL for improved management decisions.

Comparing the Effectiveness of Platelet-Rich Plasma Alone Versus Combined With Microneedles or Radiofrequency for Neck Wrinkle Treatment.

Neck wrinkles are a prominent characteristic of skin aging, with recent studies indicating that interventions such as platelet-rich plasma (PRP), microneedling (MN), and radiofrequency (RF) can effectively rejuvenate aging skin. This study aims to assess and compare the efficacy of three treatment modalities in addressing neck wrinkles. Fifteen female participants with a neck Lemperle Wrinkle Assessment Scale (WAS) score of 3-4 were enrolled in a randomized clinical trial. The subjects were randomly assigned to three treatment groups: PRP injection, MN + PRP topical PRP application, and RF + PRP injection. They received treatment once a month for three consecutive months, and a clinical outcome evaluation was performed at 1 and 6 months after the final treatment. The WAS scores and global aesthetic improvement score (GAIS) demonstrated notable enhancements 1 month postfinal treatment across all three groups, with a notably greater number of participants experiencing improved outcomes in the RF + PRP group 6 months posttreatment. Specifically, at the 1-month follow-up, the RF + PRP group exhibited a statistically significant enhancement in skin elasticity and collagen, surpassing the improvements observed in the other two groups (p < 0.05). No significant disparities in skin elasticity and collagen were detected in all groups prior to and after 6 months of treatment. Adverse events were mild and transient, such as redness, swelling, bruising, and pain. This study revealed that all the treatments can effectively improve neck wrinkles 1 month after the last treatment. A better therapeutic effect could be observed in the RF + PRP group compared with the other two groups at 6 months after the last treatment.

Symptom prevalence in patients with advanced heart failure and its association with quality of life and activities of daily living.

Quality of life (QOL) and functional status are two key outcomes for patients with advanced heart failure (HF). We examined the association of eleven symptoms with QOL and functional status impairment in patients with advanced HF. This was a retrospective analysis of baseline data from a multi-center, cluster-randomized controlled trial (NCT01459744) which enrolled patients with an implanted cardioverter-defibrillator and advanced HF at high-risk for mortality. Study instruments included the Condensed Memorial Symptom Assessment Scale, the Kansas City Cardiomyopathy Questionnaire QOL subscale, and the number of activities of daily living (ADL) patients had difficulties with. The study included 413 subjects. In generalized linear models which were adjusted for baseline characteristics, the total number of symptoms was significantly associated with worse QOL, as was the presence of each individual symptom, except constipation. Lack of energy demonstrated the strongest negative association with QOL. Similarly, the total number of symptoms was associated with a higher number of ADL difficulties (i.e., worse functional status). The presence of pain, lack of energy and drowsiness was individually associated with more ADL difficulties. Among patients with advanced HF, a higher number of symptoms and specific individual symptoms were associated with worse QOL and functional status.

Reliability, measurement error, and validity of the Arabic version of the Patient-Specific Functional Scale in patients with upper extremity musculoskeletal disorders.

To evaluate the measurement properties of the Arabic Patient-Specific Functional Scale (PSFS) in individuals with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 139) completed the PSFS, Upper Extremity Functional Index (UEFI), the Disabilities of the Arm, Shoulder and Hand (DASH), Numeric Pain Rating Scale (NPRS) and the Global Assessment of Function scale (GAF). The same outcome measures were completed again with one week in addition to the Global Rating of Change Scale. The test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the PSFS were examined. The PSFS demonstrated very good test-retest reliability (ICC2,1 = 0.82; 95% CI: 0.71-0.88), with no evidence of floor or ceiling effects. The standard error of measurement was determined to be 0.74 while the minimal detectable change was 1.73 points. The PSFS demonstrated significant negative correlation with DASH, NPRS (-0.58, -0.35), and significant positive correlation with the UEFI and GAF (0.56, 0.50). The PSFS demonstrated statistically higher correlation with the DASH and UEFI compared with the NPRS (p < 0.004) supporting our predefined construct validity hypotheses. The Arabic PSFS is an applicable, reliable, and valid outcome measure of upper-extremity activity limitations for patients with upper extremity musculoskeletal disorders.

Is partial excision of the radial head safe and effective in all-arthroscopic treatment of terrible triad fractures?

Background: Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up.Methods: We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving &lt;30%–50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging.Results: Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P&gt;0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% versus group I, 35%, P=0.02); however, there was no significant difference in ROM between the two groups (P&gt;0.05).Conclusions: In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability.Level of evidence: III.

Management of inoperable malignant bowel obstruction using the 4-step BOUNCED diet.

Malignant bowel obstruction (MBO) presents with multiple symptoms. The 4-step BOUNCED diet educates patients to self-manage oral intake according to symptoms. It includes clear fluids, thin liquids, purée and soft, sloppy foods, which are low in fibre. This mixed methods single-arm feasibility study aimed to establish if the diet could reduce MBO symptoms in patients with inoperable colorectal and gynaecological malignancies. The secondary objectives were to investigate if it was easily followed, improved quality of life (QOL) and reduced hospital admissions. Patients able to tolerate an oral diet with one or more symptoms (pain, bloating, early satiety, nausea and vomiting) were eligible. Following informed consent, an oncology dietitian took a diet history and determined which step of the diet they needed to follow using a detailed patient information leaflet. Patients remained on the trial for 28 days. Symptom and QOL data were collected on Days 1 and 28 using the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaires. Thirty patients (24 female, 6 male) aged 18-85 years consented from March 2021 to November 2022. Twenty-six participants completed the trial and 25 found the diet very easy or easy to understand. There was a significant reduction in pain from 96% on Day 1 to 63% on Day 28 (p = 0.004). The mean increase of EORTC global health status/QOL was 23.5 points, 95% CI (12.4-32.5) (p ≤ 0.001). There was a significant difference between number of admissions (p = 0.018) and bed days (p = 0.004) in the 28 days prior to consent compared to the trial period. A modified consistency low-fibre diet is easily followed, may reduce symptoms of MBO, admissions to hospital and improve QOL.

Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study.

To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD). A cross-sectional study. From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels. Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty. Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty. The study adhered to the STROBE checklist. Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD. No patient or public contribution.

Multiscale assessment of land use efficiency in functional urban areas of Munich and Augsburg

Abstract. This study aims to understand the spatio-temporal variations in land use efficiency (LUE) estimations at different scales of assessment, focusing on the per-capita built-up area within the Functional Urban Areas (FUAs) of Munich and Augsburg, Germany. The analysis is done for the time epochs 1985, 1995, 2005, 2015 and 2020. FUAs are defined as the economic area of influence in each urban area, making the study of land consumption in FUAs crucial for spatial planning and policy analysis. Land use efficiency is computed using built up surface and population data extracted from the Global Human Settlement Layer. This is done at municipal level and 100 m grid level. Furthermore, the effects of using high resolution building footprints for LUE computations are assessed. The analysis shows that urban cores and the adjacent regions are densifying with lower per capita built surface consumption while smaller urban areas utilise more per capita built surface leading to inefficent land use. It is also observed that higher resolution assessments helps in identifying varying intra-regional LUE estimates for a focused urban planning strategy development. Our study concludes that land use efficiency has generally decreased over time in the commuting zones of FUAs while the urban cores have remained efficient.

Construction and application of the emergency resilience capability evaluation scale and model for grassroots medical workers: a cross-sectional study in Guangzhou, China

ObjectivePublic health emergencies pose a serious challenge to the ability of medical personnel to respond. We aimed to establish a scientific and effective resilience capability assessment scale for grassroots medical workers and explore the way to improve resilience.Research designDeveloped a resilience ability assessment scale and applied it on the medical personnel who worked in community health service centers for more than 1 year. Related indicators were identified through literature review and the Delphi method. The established scale was given weight using the attribute analytic hierarchy process, and the evaluation model was built through the grey correlation analysis.Principal findingsA three-level indicator scale was established, which included three first-level indicators [professional quality (weight 0.346), psychological capital (weight 0.614), and emergency attitude (weight 0.040)]. The second-level indicators had 13 contents and were further subdivided into 46 three-level indicators. The overall resilience ability assessment score of 347 medical workers in Guangzhou was only 0.787. However, steady scientific-exercise habits and relative training can help improve their public health emergency resilience ability (p &amp;lt; 0.05).ConclusionThe establishment of the scale can provide a strategic basis for improving the resilience strength of grass-roots medical personnel. We should encourage this group to form a good habit of exercise, strengthen their crisis awareness by actively organizing theoretical training and practical exercises on public health emergencies, and improve their psychological capital level.Patient or public contributionIn this study, 347 medical workers from 6 basic medical institutions in Guangzhou participated in the questionnaire.

Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial.

As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy.

Formal Thought Disorders and Neurocognition in Treatment-Resistant Schizophrenia: Trouble du cours de la pensée et neurocognition dans la schizophrénie réfractaire.

Formal thought disorders (FTDs), a core feature of schizophrenia, have been subdivided into positive and negative types, and are clinically assessed by examining speech (objective) or patient introspection (subjective). Despite being associated with poorer treatment response and worse outcomes, FTDs have been understudied in patients with schizophrenia, in particular treatment-resistant schizophrenia (TRS) or schizoaffective disorder. We aimed to explore the relationship between the severity of positive and negative FTDs and neurocognition as well as social/occupational functioning in this clinical subgroup. This was a retrospective chart review conducted at the Clozapine Clinic at the Centre for Addiction and Mental Health, Toronto, Canada. We reviewed charted standardized assessment of FTDs using the Thought and Language Disorder (TALD) scale, neurocognition using the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and functioning using the Social and Occupational Functioning Assessment Scale (SOFAS) between October 2022 and June 2023. Following the original factor structure of the TALD, we computed 4- factor scores that combined positive or negative and objective or subjective FTDs. We then explored the correlation between the scores from each TALD factor and the neurocognition and functioning scores. We analysed data for 23 outpatients on clozapine. After the Bonferroni adjustment, total TALD scores, indicating overall severity of FTDs, were strongly and inversely correlated with SOFAS scores (p < 0.001). A strong inverse correlation was found between the objective positive TALD factor and Letter-Number Span verbal working memory scores, r(21) = -0.63, p < 0.001. Our results demonstrate the strong relationship between FTDs, neurocognition, and social/occupational functioning in a sample of TRS outpatients. Within the cognitive domains assessed, verbal working memory impairment had the strongest correlation with positive FTDs, such as derailment or tangentiality. These findings highlight the value of employing standardized psychopathological scales for FTDs in clinical practice.

Physical Activity Level and Time of Participation in a Water Aerobics Project for the Elderly: Analysis of the Association with Quality of life, Musculoskeletal and Osteoarticular Disorders, Chronic Pain and Body Mass Index

The objective was to analyze the association between the physical activity level (PAL) and time of participation in the practice of water aerobics with the variables successful aging (SA), quality of life (QOL), musculoskeletal and osteoarticular disorders (MOD), chronic pain (CP) and body mass index (BMI). The method has a quantitative, descriptive and cross-sectional design. The non-probabilistic sample, for convenience, comprised 101 elderly people over 60 years of age, of both genders, who regularly participate in water aerobics activities in the city of Dois Irmãos, in the state of Rio Grande do Sul. The following instruments were used: Multidimensional Pain Assessment Scale, EUROHIS-QOL, IPAQ, SOC and Body Mass Index. Descriptive analyses of frequency, comparison, correlation and multiple linear regression were used. The results showed that the irregularly active group has adequate perception of QOL and longer participation in water aerobics activities associated with lower intensity of pain perception. Likewise, better QOL and control attitudes are associated with lower prevalence of MOD.

Pengaruh Digital Financial Literacy Terhadap Perilaku Keuangan Masyarakat Kota Gresik

Financial literacy can be generally defined as a person's ability to understand, analyze, manage and communicate personal finances. Technological advances can have an impact on people's financial behavior. So financial literacy in this era of sophisticated digital technology and virtualization is very important for society, so digital financial literacy needs to be understood by the public. Digital financial literacy (DFL) is financial literacy in the form of digital financial technology. Demographic factors also influence financial behavior in society. Demographic factors can have an influence because the older you get, the more experience you have, including your financial intelligence, which also increases. This research used a sample of 125 respondents and obtained data from the results of a questionnaire distributed using the Likert scale assessment method. The analysis method uses structuralEquation Modeling Partial Least Square (SEM PLS) analysis. The results of this research conclude that Digital Financial Literacy (DFL) has been proven to have a good and significant effect on the financial behavior of the people of Gresik City. And educational demographics are proven to have a good and significant effect in moderating the influence of DFL on financial behavior.

Intensity or Duration: That Is the Main Question of the Exercise Training Management in Stroke-Induced Neurological Deficit - A Systematic and Meta-analysis Study

Background: The neurological assessment plays a crucial role in evaluating stroke patients and is a skill that has been practiced by physicians for a long time, and further refined by practitioners. The purpose of the current study was to systematically review and synthesize the evidence-based neurological assessment of the different methods of treadmill-related training protocols in stroke patients. Evidence Acquisition: In this study, the appropriate studies were documented (N = 1270) using PubMed as the sole electronic database. Moreover, subgroup studies were provided based on training intensity and duration, categorized as low intensity-low duration, low intensity-high duration, high intensity-low duration, and high intensity-high duration. Training intensities were standardized to meters per second (m/s), and the training duration was calculated in terms of minutes per session, the number of sessions per week, and the total number of training weeks, which were then converted into minutes. The assessment of neurological recovery following stroke was conducted using standard neurological assessment scales. Results: This meta-analysis in humans found a notably positive standardized mean difference in protocols with high intensity and high duration (1.792; 95% CI = 0.566 to 3.02). Conclusions: In conclusion, the current meta-analysis suggests that practitioners using the high intensity-high duration protocol should regularly monitor the neurological outcomes, as they may be negatively impacted by the intensity and duration of the protocol.

Assessing pain management in total joint arthroplasty using the Detroit interventional pain assessment scale—A prospective cohort study

BackgroundTotal joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.MethodsAn IRB-approved prospective study was conducted at a US academic joint replacement practice. Patients were evaluated by an independent observer at three weeks, three months, and six months postoperatively using the Detroit Interventional Pain Assessment (DIPA) scale. Patients verbally rated their pain with their current medication regimen as 0 (no pain), 1 (tolerable pain), or 2 (intolerable pain) on the DIPA scale. Narcotic usage was verified by the Michigan Automated Prescription System (MAPS). Patients were divided into THA, TKA, previously on opioids, and opioid-naïve groups. Provider efficiency scores reflected pain management satisfaction and were calculated as the percentage of patients reporting no pain or tolerable pain.ResultsOut of 200 patients, the percentage of patients using narcotics and their daily usage (MMEs) significantly decreased from 75.5% (27.5 MMEs) at three weeks to 42.9% (5.3 MMEs) at six months (P < 0.001). In 80% of patients, narcotics taken at six months were prescribed by outside providers. Significantly fewer patients used narcotics at six months for THA (15.4%) compared to TKA (52.7%) (P < 0.021). There was a significant difference in daily narcotic usage between patients who took narcotics preoperatively (22.9 MMEs) and opioid-naïve ones (13.4 MMEs) (P < 0.001). Provider efficiency scores were best at three weeks (76.6%) and three months (70%) but declined at six months (57.2%).ConclusionsNarcotic tapering practices were observed as postoperative daily narcotic intake decreased across six months. However, outside providers prescribed 80% of narcotics at six months, necessitating a better-coordinated practice with surgeons. Patients taking preoperative narcotics experienced higher daily MME requirements than their opioid-naïve counterparts. In terms of the percentage of patients on narcotics, THA is a better procedure for tapering patients off narcotics by six months.

Risk Based Regulation in Quality Assurance: Selection of (and Benefits Experienced by) Registrants Undertaking Regulator-mandated Peer Review

ABSTRACT: Purpose: To identify risk and protective factors associated with physician performance in practice; to use this information to create a risk assessment scale; and, to test use of the risk assessment scale with a new population of assessed physicians. Design: Physician assessments that were completed by community-based physicians between March 2016 and February 2022 (n =2708) were gathered to determine what professional characteristics and practice context factors were associated with poor peer practice assessment (PPA). The predictive capacity of the resulting model was then tested against a new sample of physician assessments completed between March 2022 and February 2023 (n =320). Results: N=2401 physicians were eligible for inclusion in a logistic regression analysis, which resulted in an empirical model containing 11 variables that was able to account for 21.6% of the variance in the likelihood of receiving a poor PPA generated by the College of Physicians and Surgeons of British Columbia. The resulting model, when tested against 320 new cases, was able to predict good versus poor PPA performance with a sensitivity of 0.79 and specificity of 0.75. Not having undertaken peer review (OR=1.47) created a risk like that arising from a full decade passing since completion of medical school (OR=1.50). Conclusion: In addition to being the largest known study of its type, this work builds on similar studies by demonstrating the capacity to use regulator-mandated peer review to empirically identify physicians who are at risk of substandard performance using factors that are safe from claims of violating Human Rights Codes; that emphasize modifiable aspects of practice; and that can be readily updated to account for change over time.

Curcumin on Human Health: A Comprehensive SystematicReview and Meta-Analysis of 103 RandomizedControlled Trials.

The aim of this meta-analysis was to determine the effect of curcumin on a range of health outcomes. PubMed, EMBASE, Scopus, and Web of Science were searched from inception until September 2023. Randomized clinical trials (RCTs) that compared the effect of Curcuma longa L. with placebo were considered eligible. The risk of bias and overall certainty of evidence were assessed using the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. We meta-analyzed the effect sizes across eligible studies using the random-effects model. In total, 103 RCTs on 42 outcomes were included, incorporating a total population of 7216 participants. Overall, 23 out of 42 (55%) outcomes reported statistically significant effect sizes. The credibility of the evidence was rated as high for fasting blood sugar (FBS), C-reactive protein (CRP), high-density lipoprotein (HDL), and weight. The remaining outcomes presented moderate (waist circumference [WC], hip circumference [HC], body mass index [BMI], insulin, Homeostatic Model Assessment for Insulin Resistance [HOMA-IR], quantitative insulin-sensitivity check index [QUICKI], leptin, gamma-glutamyl transferase [GGT], glutathione [GSH], and superoxide dismutase [SOD]), low (14 outcomes), or very low (14 outcomes) evidence. In conclusion, curcumin supplementation can modify FBS and some glycemic indices, lipid parameters, as well as inflammatory and oxidative parameters. This updated summary of the accumulated evidence may help inform clinicians and future guidelines regarding medical and scientific interest in curcumin. However, due to limitations in the methodological quality of the included studies, well-designed and long-term RCTs with large sample sizes are needed. Trial registration: PROSPERO: CRD42021251969.

Muscle energy technique versus Maitland’s mobilization on shoulder pain and disability after neck dissection surgeries

Background. A substantial number of patients who undergo various neck dissection procedures experience shoulder dysfunction and pain, which can significantly complicate or disrupt daily routines, social engagements, and overall Quality of Life (QOL). Muscle Energy Techniques (MET) and mobilization have been demonstrated to effectively reduce shoulder pain and disability. Objective. The objective of this study was to examine the therapeutic benefits of MET and mobilization in improving shoulder pain and disability following neck dissection surgeries and compare these two techniques’ efficacies. Design. The present study employed a randomized, single-blind, controlled trial Methods. Thirty patients between the ages of 25 and 70 (13 men and 17 women) with shoulder dysfunction following six months’ post-neck dissection surgeries were enrolled in the study. Patients were equally randomized into two groups of 15per each: Group A received the Muscle Energy Technique (MET), and Group B underwent Maitland’s Mobilization. Both groups participated in identical conventional physiotherapy regimens. Both interventions were administered at a frequency of three sessions per week over four weeks. Visual Analogue Scale (VAS) for pain assessment, Shoulder Pain, and Disability Index (SPADI), in addition to shoulder range of motion (flexion, abduction, and lateral rotation), were measured before and after four weeks of intervention. Results. Following four weeks of intervention, both groups exhibited significant improvements in VAS, SPADI, and shoulder flexion, abduction, and lateral rotation, with p values ≤ 0.001. A comparison between the groups showed a statistically significant difference in all measured outcomes, favoring Group A, with p-values &lt; 0.001. Conclusion. The Muscle Energy Technique (MET) and Maitland’s Mobilization were effective therapeutic strategies for alleviating shoulder pain and disability following neck dissection surgeries. However, the results showed that MET outperformed Maitland’s Mobilization strategies.

Effect of cognitive training on selected gait parameters in patients with stroke

Background. Not only may early cognitive rehabilitation help stroke patients with their cognitive impairment, but it can also help patients restore their capabilities to do everyday activities. There isn’t much data on how cognitive training affects spatiotemporal gait variables in stroke survivors. Objective. To examine the impact of cognitive training on selected gait parameters in stroke patients. Subjects and Methods. Forty male and female patients with mild ischemic chronic stroke, ranging in age from 45 to 60 years, were recruited and distributed into two equal groups at random (G1 and G2). The Montreal Cognitive Assessment Scale (MOCA) and the Rehacom system were utilized to evaluate the patient’s cognitive function. The Biodex gait trainer device was utilized to measure several gait variables for all patients. Rehacom cognitive training and a selected physiotherapy program were administered to the study group (G1). The similar selected physiotherapy program utilized for the G1 was applied to the control group (G2). For eight weeks, the treatment was administrated three sessions each week, day after day. All variables were evaluated before- and after-intervention. Results. The step length and walking speed, as well as the MOCA scale score of G1, were significantly higher after treatment than those of G2 (p = 0.001). The correlation between step length and median reaction time (MRT) was moderate negative significant correlation (r = – 0.698, p = 0.001). Conclusion. Cognitive training has a beneficial impact on improving the selected spatiotemporal gait parameters in stroke patients.

Validation of the Internet entrepreneurial self-efficacy scale among Romanian technical students.

This study's aim is to evaluate the Romanian version of the Internet Entrepreneurial Self-Efficacy Scale (IESES), a new assessment scale for online entrepreneurial self-efficacy, and estimate its psychometric properties in a sample of engineering students (N = 644; 317 females). The scale was translated and adapted into Romanian through a forward-backward method. The factorial structure was investigated using Confirmatory Factor Analysis (CFA) and multigroup-CFA for gender invariance. The scale was associated with instruments that measure entrepreneurial intention both traditionally and in the online environment (Individual Entrepreneurial Internet Scale and Entrepreneurial Intention Questionnaire) and components from the Theory of Planned Behavior (attitudes, subjective norms and perceived behavioral control). McDonald's omega and Cronbach's alpha coefficients were used to assess reliability. Traditional statistics are complemented by network analysis. Results show that adequate matching items for the 3-factor model and complete gender invariance is maintained. The three factors are associated with the internet and traditional entrepreneurial intention, and the components from the theory of planned behavior (attitudes, subjective norms, and perceived behavioral control). Internal consistency is excellent because α and ω values range between 0.834 and 0.919. In addition, discriminant validity was demonstrated. The network analysis suggests the relevance of technology utilization in the self-efficacy of online businesses in the case of engineering students. Overall, findings enable us to conclude that the Romanian version of the IESES is a valid, accurate instrument that can be implemented to evaluate self-efficacy related to the successful execution of an online business.